tv Charlie Rose PBS December 3, 2014 12:00am-1:01am PST
>> rose: welcome to the program. we begin this evening with anthony bourdain. >> being a chef, cooking conditions you to the tiny technical satisfyions of properly executing a single plate. having kind of a private moment when that plate sits there momentarily in the window before it goes out into the dining room to be ruined, where you look at it, we know that you did this particular thing well. it's a very private moment. i think that's been useful in being, learning to like something so temporary, so fleeting. i think that's been useful in being happy in television and writing.
i like the process, the editing process, the pre production process, the nuts and bolts, again the technical satisfaction of putting these pieces and elements together in conjunction with other people, and having one tiny golden moment where you say that's pretty good. >> rose: we conclude with dr. john noseworthy of the mayo clinic. >> we were the first and now we're the largest integrated multi-disciplinary group practice of medicine rooted in research and education. essentially the guiding purpose of the clinic is the needs of the patient comes first and we do our work with teamwork. and that's essentially what2'we. >> rose: bourdain and noseworthy next. >> rose: funding for "charlie rose" has been provided by the following:
>> rose: additional funding provided by: >> and by bloomberg, a provider of multimedia news and information worldwide. captioning sponsored by rose communications from our studios in new york city, this is charlie rose. >> rose: anthony bourdain is here. he is a chef, author, television personality. he is known forf15o his candid approach and appetite, fellowship. they have called him the indiana jones. he explores food and culture. y completed his fourth season, competition series the taste begins its new season this month. i'm pleased to have anthony bourdain back at this table.
welcome , sir. >> thank you. >> rose: you seem -- >> i'm coming right from jujitsu. i started at 58. >> rose: 58. >> it's the last thing in the world i could have ever imagined wanting to do or enjoying. i wasn't at the gym, i never really cared. at my age to learn an entirely new skill is deeply satisfying. to recreate that feeling of being the lowest person in the toe actual pole in a kitchen back when i was 17 knowing nothing in a very hard world. the incremental tiny satisfactions of being a little less awful at something every
day. with jujitsu, i'm learning a very physically demanding one but one that i think about for the rest of the day. they call it physical chess because it's something you think about. >> rose: what do you think about your trajectory. >> i like making thing. when i was a chef i was somebody who liked multitasking. i think i like making things whether it's a tv show, a story, a plate of food. i don't really even need to have it afterwards. the process. i think being a chef, seconding conditions you to the tiny technical satisfactions of
executing a single plate. having kind of a private moment when the plate sits there momentarily before it goes out to the dining room to be ruined. we look at it and you know you did this particular thing. it's a very private moment. i think that's been useful in being learning to like somebody so temporary, so fleeting. i think that's been useful in being happy in television and writing. you know. i like the process of, the editing process, the preproduction process. the nuts and bolts. again the technical satisfaction of putting these pieces and elements together in conjunction with other people. and having one tiny golden moment where you say that's pretty good. >> rose: do you have the capacity, i mean you seem to have a value structure as well,
a personal value structure of things you don't want to do. you never wanted to march into the whole product endorsement thing as one example and other things. you knew what you were capable of doing in terms of a value structure, and not capable of doing. it just seems like for those things you were not capable and you just couldn't do them. it was like congenital to you. >> it's not a matter of integrity. i think there's always the quality of life issue, will i be happy, will i be able to live with whatever decision i make today, will i be able to live with it tomorrow, a year from now. i think having made so many mistakes in my"ultimately helpf. i think achieving any kind of success only at age 44 also was helpful in that i've learned how to say no to things that might hurt me or make me unhappy.
>> rose: that might make you unhappy or do damage to you. >> i do a lot of, most of my creative and business decisions are based on simple principles. who will i have to speak to on the phone on a regular basis. and if it's somebody who i don't, if the phone rings and i pick it up and it's someone i wouldn't ordinarily want to hang out with or have a conversation with or go to dinner w i certainly don't want to be in business with them. i don't want that in my life. it will lead to bad stuff and i want to kept that away. >> rose: you mentioned two things that are enormously important to you. your wife and your kid. >> yes. >> rose: changed you in a way. >> yes. >> rose: i mean you found your wife when you weren't really looking for a wife. >> true. we met on a blind date organized by our mature friend eric rivera. and i think his words were she's crazy, are have fun, she's crazy
just don't get serious. >> rose: and you got serious. >> we got serious. i was a guy who i think until age 50 as much as i might have yearned for a child and wondered what a quote unquote normal live might be like, i think at 50 i recognized i wasn't up for the job. at some point after meeting my wife, i think i had that thought again, wouldn't it be cool to have a child. but when this time came the knowledge i'm ready. i'm actually old enough. i would be good at this. i not only want to but i can. >> rose: and whether you would be good at it. >> it's necessary to be good at it in my view. you0"rz don't, you owe everyth. i've done a lot of things in my life. i've disappointed people in my
life and this is something i felt very strongly and i wanted to get write. it's such a wonderful thing, however, to suddenly find you're no longer the star of your own movie. it's such a great thing to realize it's just not about me anymore. it's about this little girl. that is an enormous pleasure and a privilege and a fleeing. i feel relieved of a burden am =1e.>> rose: you said i think once you were holding her in your arms this is bringing so much satisfactionwever imagine. >> yes. especially to be the father of a little girl. to be a father to a little girl is a particular delight. >> rose: that's the way it is -- >> i don't know about other fathers. >> rose: it's also to know about heroin and crack cocaine. it's, you know, to know you now,
not know you then, you say this doesn't fit. he's too smart for that. >> there are plenty of smart people on drugs. and i lookóbvv back i was deliberately doing stupid thing. with malice aforethought. if you told me do not do that, i would certainly with determination head for the really stupid one. >> rose: why? >> i really don't know. i think i just wanted ... was not happy i guess with something, was not satisfied with the world the way i saw it. and i only made the right decisions for most of my life when i exhausted every other option. >> rose: because i think to look at your show, i think i
understand why it's so good. why do you think it's so good without beingbecause it is you. >> i work with the same people i worked with for 14 years. we're a very tight group of people to love film, who enjoy their work, who experiences at the beginning an extraordinary amount of freedom to be creative. we have fun doing what we're doing. we insist on having fun doing what we're doing. we won't have it any other way.ñ we're a hand crafted outfit embarked on an adventure together doing our very best to keep it interesting to ourself to find new ways to tell often similar stories. >> so that's the interesting thing. find new ways to tell stories.
it's not about finding new stories to tell as much as it is finding how the how to tell the same story. >> we're asking simple questions and often it's the same story. i go somewhere and eat something and i filed some conclusions or i don't and come home. >> rose: over food you talk about who they are and what they're about. >> what makes them happy. >> rose: what makes them happy. >> that's actually a pretty complex story if you're asking those questions in congo or iran or libya, you're going to get some very surprising, very nuanced very complicated answers. >> rose: that's -- >> looking at a completely different story. that show was really about heroin, it wasn't so much about
a place. i went back to province town subtracting my own progress or deeper and deeper into drugs alongside what is emerging as a major heroin epidemic in small town new england. >> rose: now heroin not crack cocaine. >> it's heroin. it's a story when i first started reading about it, the small predominantly white rural norman rockwell towns all over america that have moved fromcle.
i find it interesting and it's also the most likely the best argument for depicting heroin as a public health problem rather than a criminal justice problem. it's going to be easiest to sell at what precise moment did it become a criminal justice problem, this addiction, you know. who is a junkie and who is somebody who just has a you know, been overprescribed. those questions become sort of tricky to answer. >> rose: why are you going in a sense. you're now on cnn and doing the other thing too. cnn often talks about you as representative of the future, that what you have done is representative of the future of where one cable network wants to go. where are you going? >> i don't, i'm not looking. >> rose: nothing about me
sees you as a guy who has planned his life out. >> where am i going? i mean, i see what we're doing as an adjunct to the news. we're telling stories about people's every day lives more often than not , that i think ae useful when you read about what's happening in iran right now. who are we talking about? >> rose: have a meal with them and reflect whether or not you like or hate america but who they are and what their life is about. >> we don't see that side. it's uncomfortable sometimes, confusing, complicated, things that television generally abhors. but i mean it's a big world. i'm just going to keep going, doing what i'm doing as long as it's fun, as long as we find
creative ways to tell those stories. >> rose: and what's for dinner>;rtñ just the way to mee. in other words the idea what's for dinner, you walk in. >> yes. what makes you happy, if you left home, i often ask this. if you've been away from home for a while what's the food, what's the dish that you crave, the first thing you want. the first experience around food or drink that you want to have when you get back. and you know, there's a lot of conversation in -- informationn the answer. it has a lot to do with who is eating, who is not eating, what your socio-economic situation was growing up, who have important to you in your family,
ethnically where this came from. it's fascinating and the other stuff intrudes. we never intended to become a political show but as i've often said there's nothing more political than food. >> rose: exactly. and culture and politics. roll tape. this is a scene from province town and we'll see another one where he first worked as a cook. here it is. >> many of the old places in p town are gone. but the lobster pot is still going strong all these years later. and still has what i want and need, the essentials. my friends worked in the kitchen here, starting the tradition among my set that cooking work was global poi. at that point i never intended a career as a chef. >> i was getting to that. >> oh yes. >> so this is home portuguese kale soup. >> portuguese kale, just what i
remembered. kale fiery red chorizo, kidney beans, potatoes. that was precisely what i loved about the food here. the portuguese thing. dishes like this stuff, cod crusted with brown portuguese sausage, breadth crumbs, stuffed with scallops and crab, some sherry red sauce. i wasn't working for a while and he comes home from work and says our dishwasher didn't show up today. you're our new1$#ñwi said oh re. i put one taken it off for 30 years. i would wake up hanging on the beach until 2:00, 3:00. >> yes are it was fun. >> roll into work, work all night. drinking,=+?2ñ getting high, drg out food. you got all the food you wanted, all the liquor you wanted. >> all the sex you wanted. >> all the six you wanted.
>> it was true, it was fun. >> and it was still an essential part of the economy. >> it was a lot of fun believe me i remember. >> rose: tell me who he is judicial that's john inlling who back in the early 70's still owns and operates a pizzeria called spirit of pizza province town and he's a major employer in time for my knuckle head friends and an essential figure in life and now respected elder spaceman in the town of province town. >> rose: are you better, can you see progress year by year because of a town of people you brought together in terms of how you present the material that you see. >> somebody asked me what other documentarians. we look at dramatic films, films we love, foreign films, old
classic films with storytelling style, time line, cinematography, editing and we use those as reference points. >> rose: feature films. >> well for instance, it has a really interesting structure as well as its time line and keeps looping and folding back on itself. so we're often looking for an opportunity to use a device like that or style. >> rose: do you sit around and watch that and say look at this, we've got to see this. this is really interesting or does somebody just watch it and then take that lesson and incorporates it. >> i tend to watch and run down to the lobby and my crew would say okay look, we have to do a film, where can we go to do that. i want that look, i want that kind of flush camera angles and movements. and like i said we're all film, it's fun it gets us all excited,
they all go out and watch all those films and then we'll start talking about how we're actually going to do that and you know for a@ 5than i imagine it cost. >> rose: do you imagine yourself as a filmmaker, i kind of am. i produce films, i produce are independent films working on two of them now. >> rose: like what? >> i'm working on a documentary for cnn with the same people i work with, it's a full length feature on a famous chef, put it that way. and another project that we're developing. >> rose: fair enough. this is what, this is research about you that's really fascinating because we talk about mission statement and thy ask soldiers, athletes. this is it. anthony bourdain quote i'm not
looking to create a permanent brand it's a quality of life issue with me and having fun and surrounded by people i like. are we prownld what we're doing, do we have anything to regret when we look at tomorrow, those thing are huge to me. that's a mission statement. >> absolutely. >> rose: that's the kind of place, that's what we want to create. >> these are things i was talking about as values. i know what it's like to look at a mirror and not be happy with what i did yesterday. given the opportunity and i've been very fortunate to avoid that feeling. yes. it's important to me to feel good about what i did yesterday. >> rose: take a look at this. so going into this. >> yes. >> rose: give me a sense of where your head was. >> well, i've been trying, i've been wanting and trying unsuccessfully to get to iran with a film crew for five years. >> rose: because you intrigue by the place. >> i'had heard from)
zñ a few peoplewho had been thae surprised. that the mood or the way i would be treated on the street by order iranians was very much at odds with the iranian we know from the news and deal with as a regional super power. i heard the food was fantastic and i knew very few people had had the opportunity of doing a show that i was interested in doing. that+ó+> was ordering and showig people. this is something i was trying to do for a long time. the window opened and appeared at the time that maybe it was opening for good, we didn't know. suddenly we were allowed, others were not. but we were allowed. >> rose: they said yes you said yes. >> finally. and we really did our very very best, we knew that this is an incredible opportunity and we went in and we tried very hard
to do the best work we could. >> rose: and did it change your limited impression of iran? >> it's so confusing. i seriously said that very few places i've ever been have been as overtly friendly to us just by virtue of being american. incredible curiosity. where are you from. america. oh, fantastic. have you eaten this. you should come to my house. this under the, you anyway, the down with america mural on the wall. very friendly. and very just very different than how we are sort of conditioned knowingly or not to expect iran to be. and just look. it feels kind of like barcelona
or the suburbs of rome in tehran. that said, everything's fine until it's not. and as we found out with someone we spoke to in the show, suddenly it wasn't good at all. we had someone who was with us on the show, lovely person behaved impeccably. shortly after the show, was arrested and basically disappeared into the prison system and has not been heard from since. >> rose: here it is. take a look. parts unknown, iran. >> so far iran does not look, does not feel the way i expected.
neither east nor west but somewhere in the middle. >> well it looks spectacular. >> you can't have this. it is time consuming. it's very expensive. cuisine has to be experienced in somebody's home. >> okay. >> so this one here is called [indiscernible] >> in yogurt and saffron. >> prominent art gallery owner insisted i come for lunch with her friends and family. >> here we have sour cherry rice withm@:k(rr(9 m,p[h,p[ñ>> more than any i thie family for generations. rice nixed with oh got and
saffron and baked. don't think of rice as a side dish around here, it can be the main event. >> okay, very very good. >> you put far more on the table than anyone could conceivably eat. if you)d tonight like your guet you don't put anything. [laughter] >> and here is a large meat ball. >> ground beef, onion and cooked rice, walnuts, fried apricots and boiled eggs. >> this is enormous. we take you to our hearts and all of that and you are extreme in so many ways. >> do you see this tortured relationship between america and iran for many years, how do you
think most americans will react when they see this. [laughter] >> rose: what was the answer to that? >> i said aren't you the axis of evil and he said we're just ordinary evil like everybodyels. it's so confusing. the women in particular, very assertive, very opinionated, very different. we see the hi ab, we're aware of the religious police, we hear what is said by the government and the clergy. but how people talk and hold b$ówn]]tz and it's verysurprisi. >> rose: somebody speculated that if you go to certain middle east countries, the more the regime loves america, the more people hate us. and the more the regime hates us, the more the people love us. they may use iranhñh at the best
example. >> don't know. there's certainly the shah. >> rose: he was iranian. >> yes. this is a country, very old empire with a deep traditional love of poetry and music. >> rose: and film making. >> and film making. things that are very much at odds, the official attitude towards these deeply persian characteristics. very conflictive, very ambivalent and you can see it placing out unspoke unway in the street what is permissible, who do we want to be, where are we going. there is a real simmering up of
something, a feeling like somebody. it's not like, it's, i got the feeling sometimes in tehran if someone were put pull up, put a couple speaker outside of their car and start playing dance music everybody like a broadway musical everyone would start dancing. >> rose: i got it, yes. thank you for coming. a pleasure. >> a joy, always. >> rose: anthony bourdain. back in a moment. stay with us. >> rose: john noseworthy is here. he's the president and ceo of the mayo clinic. they named the mayo clinic the best hospital this year. it's celebrating the 150th anniversary. it's under going major changes including a 20 year $6 billion to make downtown rochester a destination medical center. i'm pleased to have dr. john noseworthy at this table. with el come. >> thank you charlie. it's a privilege to be here. >> rose: thank you. for those who don't know i think everybody has some appreciation that the mayo clinic, and it waí
the first break medical institution that reputation precedes you and goes a long way back. tell me about it. what is it that makes it distinctive in your judgment? >> well as you said it's 150th year. we were the first and howsi thed multidisciplinary group practice of medicine. rooted in research and education. and essentially the guiding purpose of thet%sm÷ clinic is te needs of the patient comes first and we do our work with teamwork. and that's essentially what we've done for these 150 years. we have a wonderful staff completely committed to the patients. and our research and education movers that anything forward to meet the needs of our measures and to predict the future needs where our healthcare needs need to go. we have some features that i'm sure you know. our physician are salary, the institution is physician lead but every physician leader is paired with an administrator to make sure the business works
well. we have a committed stat staff. we're not-for-profit, humanitarian organization. we branched out from rochester into arizona and florida and now we built a large network of affiliated hospitals and healthcare groups which we share or information so they can provide better care to folks around the nation and in mexico and puerto rico. so it's a privilege to work there. >> rose: my impression is that a patient at mayo clinic has at his or her a whole group of experts in a variety of fields and they're the kind of look at that patient's well being coming from many directions. >> one of the innovations that's over a hundred years old now was the single@and so it started iny 1900's. so when a patient came to mayo, the record of that patient was shared with the other healthcare providers, the other physicians,
nurses wherever and wherever the patient went the record went with them. prior to that and for much of the 20th century doctors k ept their ledgers private. at ajello the clinician sees you first and then they meet either face to face or electronically. and after two or three days longer if necesséis summed toge. it's a holistic approach and worked very well. >> rose: is it in any way a teaching institution. >> it's one of the largest teaching institutions in the country. we train 1500 specialists a year. we have a large graduate program, a medical school program that kind of thing. and the allied health school is very large, thousands of allied health professionals. their goal is really to train the work force of tomorrow. so currently we're working a the what does the healthcare work force look like, five, 10, 15
years down the road. we're always trying to be a step ahead of the game. >> rose: how does ten years look. >> it look different than today. it could be bemplet there's a movement in the developed countries to share what we know more broadly across physicians. i think our patients are expecting that. the consumers are more engaged, and are now becoming patients if you will. they're expecting and indeed they deserve that patient centered care. it hasn't really happened yet broadly but i think it will. i think patients will take a greater role in making the decisions in their life. healthy decisions about tobacco and alcohol and food and exercise and spirituality and all of those things. so i see that moving forward. i think the younger people are going to want to emphasis on digital technology so they have with a they need 24/7 to make their choices. i think that's a good thing. the united states doesn't have a sustainable high quality healthcare system at the moment
as we all know. it's heavily fragmented and quality is uneven and wasting a lot of money and we're not investing enough in our research activities. >> rose: why. >> i think it's just grown up organically over many years. physicians were trained and still are trained to work in isolation as opposed to in teams. we need toand i think we will gg forward but mayo's very much trying to create that sustainable future both for ourself but sharing with of that with anyone who wants to learn from us. >> rose: it's has an amazing impact on medicine and today more cutting edge than ever before. the more i talk to people like you one is the machines that give usi-ññp- more power to look inside the human body. and secondly, it is,u! we're getting tons of information that we never had. so you can see disease in a broader spectrum as well as a
deeper personal perspective. >> that's just going to continue to accelerate there's no doubt about it. with the human genome work that's now becoming affordable, we can now do a whole human genome testing for under a thousand dollars and that will come down further. people will have their human genome done and keep that in place and as new advances come forward they'll have it updated. now we know more than we knew last year and these are the diseases that you might be me disposed to have and candidly f you develop a disease we'll say for you that's right don't bother with that one it's not going to work with you. one example might be patient with breast cancer or any kind of cancer for that matter. we call it breast cancer but we know from our human genome work or genetic work that some breast cancers behave more like lung cancers or pancreatic cancers or colon cancers if you will. by doing the genomic on the tumor itself we can say it came
from the breast but if we use breast treatment on this patient they won't respond. individualizing our treatment will be better and improve outcomes. >> rose: what did the affordable care act accomplish and what did it not accomplish? >> the president refers to the affordable care act in the state of the union this year as health insurance reform. and i thought that was an interesting choice of words because that's essentially what it did. it got a lot of americans insured. about eight million to ten million people. at least having insurance. and physicians seems to be taking those patients into their practice so that's been a good thing. what it didn't do very much of and what needs to happen next is really healthcare reform, we need to modernize the payment system. that's a government activity for medicare particularly.
and we in the health profession need to modernize the delivery system. so we provide more integrated and more efficient care. and ultimately what we think the government, the work that needs to be done now in the government needs to recognize that there is a spectrum of complexity, and charlie there's a spectrum in outcomes. not all care is the same. complex care ought to be recognized as complex care and better outcomes more efficient safer care ought to be recognized and hopefully rewarded at some point. the place like the mayo clinic and other large academic medical orgainizations. end up with patients who are very complex. so perhaps not just a regular hip operation but a repeat or someone who had a hip infection as well as their hip surgery. or they're obese, they weigh 400 pounds and no one will operate on them. let's a complex, more complex puzzle than standard and at the
phone there's nothing in the system to recognize that you got the diagnose right and you did the surgery that you should do or you didn't do the surgery that you shouldn't do. that's one next step in the healthcare reform. i think you've already alluded to there's tremendous opportunity for technology to advance how we practice medicine. so using mobile technology, we can now use robots and digital cameras, to put a neurologist in a rural hospital and within a minute identify whether that patient needs block busting treatment for their stroke and the doctor can determine whether the patient had a concussion. but there's no reimbursement for that. as much as it's nice to be reimbursed if we're going to advance and bring technology on, the system needs to reward that excellence or innovation. that's where america has always
been the cutting edge. excellence in the country with the government defunding nih and with the fact we haven't modernized the payment care system. candidly we need the courage sometime as a country to take on sustaining medicare. it's really important that this country have a strong medicare program but it's a leading driver of the federal deficit. and that's a political issue. >> rose: it's a political issue and it has to do with the years of dialogue and debate about it. so it became more political and had to do with either economics. if you were designing a system would you make what medicare delivers the better way to go. >> well medicare's payment system is for those over 65. >> rose: would you make it for people who are over 21. >> well candidly, medicare doesn't fully reimburse for the care that's given and for most of us in the not-for-profit sector who deal with complex care, it pays for roughly 60% of
the total costs. so it's hard for those of us in the academic medical world to manage to medicare rates of payment. you do a lot with efficiency. we can drive out waste but unfortunately it doesn't really cover the cost and the doesn't really recognize as i mentioned the spectrum between getting it right and not getting it right. we're often penalized for getting the diagnosis right and not doing the surgery, not doing additional tests as opposed to the are future service environment which is still the way medicare's paid. >> rose: that should be changed. >> that should be changed. >> rose: what are you learning in research? what's the cutting edge of research telling you? you and i participated where the nobel laureate talked about where you can take the stem cells and take it about aing and create embryonic stem cells. >> we can take a piece of your
skin charlie and we can grow a heart muscle or pancreas or bone or brain tissue right out of your skin and then give that back to you. so we're personalizing medicine now using stem cells. and that's an area that's really going to develop going forward. >> rose: on a scale of zero to a hundred probably five. and 50. >> well i don't know what the scale actually means but i think that there are now studies in patients with hard disease using their own stem cells to repair damaged heart muscle. >> rose: we are fixing heart tissue. >> fixing heart tissue. >> rose: with step cells. >> fixing wound healing with step cells. we are looking at muscular dystrophy and parkinson's disease. >> rose: looking at it means it's five to ten years off whatever the percentage is to double that. >> we have human trials coming out in those areas to see
whether stem cells will actually prevent degeneral race and lead to repair of multiple sclerosis. >> rose: the field of multiple sclerosis what's the promise there. >> the brain is very complex, we have so many neurons and they connect with thousands of other cells. that's tough. if we as humans had to figure out how to program the tissue to do that work i believe we would hail. we believe there's something inherent in the genome that tells those cells what to do. we need to release that opportunity. we're investing heavily in stem cells, we're investing heavily in mayo in work we do with individualized medicine we talked about that with human genome. and a more mundane level perhaps is using engineering principles to how we deliver healthcare more efficiently. doesn't sound very interesting. >> rose: what is an engineering principle. >> using work flow essentially mapping work flow and allowing
surgeries to do more efficient surgeries so they can do more with fewer operating rooms, get patients home a day or two earlier. those are all big stems we can take to reduce healthcare costs. >> rose: as ceo my impression is since you've been about you've changed economics with mayo clinic and you have gone from institution that was in not great financial place and have given it much more viability, not that it is failing but more viability. have you done that primarily through cost efficiencies or something else. >> about ten years ago we could see what was coming with the healthcare system in the country. we knew there would be less revenue and we knew the consumers would be getting more engaged in their healthcare. and there would be more of them. and research is going to be under funded so we essentially put a plan in place to manage our expenses and try to grow
revenues. it's hard to grow renewals. we still do. and reengineering how we work so we're more efficient. there's a limit how far one can go with it. >> rose: the famous is clinic that the doctors have run the institution. why is that. >> the decision was made early on that a!,x physician-led organization -- they followed our model and worked well there. essentially healthcare issues putting our patients first it seems to work best if physicians are involved with that as opposed to making business decisions. we need to make business decisions but it works well having physicians advise other physicians how they should work. it's managing change charlie. there's continuity with 150 years but we've never undergone this rapidity and change alan the last five years. that comes from market shift,
affordable care act and other thing that are putting huge pressures on the medical profession and we need to do a lot of change and it's hard to change patterns. you've been in practice for 30 years you've done it this way etcetera. >> rose: there is an article that suggested doctors are increasingly unhappy with their practice of medicine. >> yes. well there's an issue, there's a phenomenon called burnout that's been written a lot about in medicine. that's a big deal. almost 40% or give or take 40 to 43% of physicians whether they're specialists or primary care physicians report a feeling of deep personalization and de detachment andc,wyñ loss of int. >> we're not immune. we have burnout. the pressure is such that folks are losing that ability, that flexibility that's so important in their work. and there have been recent reports that 90% of physicians would tell their kids don't go into medicine you end up with a
huge debt it takes you forever to get there. >> rose: how will you fix that problem? >> well there are a number of things that need to happen. >> rose: more structure and sustainability. >> i personally think it's a great time to be in medicine great time to be in science because the future is ahead of us. we have to embrace change and be willing to make the courage. >> rose: the government has to fund the research aspect of it. >> the government has to be involved. there's a role here. the u.s. has always been the number one in innovation. not only in stem but they are losing interest in that long term investment and we need to make those investments. >> rose: the government's losing it because of its own politics in washington overfunding and taxing and budgets. >> yes. the private sector is burning thing. we at mayo are turning to the private sector to our benefactors and again to our
income. >> rose: would medicine be better off if there were a lot more mayo clinics around the country? >> well that's for others to judge. we think it works well. it's not that easy to duplicate the culture, that patient-centered culture. that's been the hardest thing for others to duplicate. all things are happening in the market with hospitals getting bigger and bigger the for profits and not for profits coming together with insurance companies and so on. myoclinic says that doesn't sound like a patient-centered answer. how are the patient going to benefit if the hospital system just gets bigger and bigger and bigger. it provides them purchasing power so they can besuccessful. instead what we the decide to do knowing we couldn't scale our culture like that across the country. we basically digitized our knowledge of how we work as a group practice and we made that into tools that others can subscribe to. to help them provide better care
locally in kentucky and÷califord puerto rico, and we're finding the affiliate model, mayo's model helping others provide better car. they're able to keep 80-85% of home and never send them to mayo clinic. the 10-15% that do need to come come for a specific reason. it reduces care, cost and the outcomes are very good. but that's a different model. >> rose: i want to come back to two questions. number one the idea this is the place where people often with limited resources come because they know they get the best healthcare anywhere especially for certain kinds of specialties, kings and moguls and lots of other people come to the united states and you'll read the story of them being here. are you saying we'll lose that if we don't pay much more, in we don't pay attention to what we have to do to understand what produced that and make sure we continue to produce it. >> i think people recognize
excellence. and they'll go where there is excellence. you have to understand, we see kings and wealthy people but they're way less than 1% of the patients that we see. but we need to fund excellence to deliver -- >> rose: people will go anywhere in the world to get the best care and they choose to come here most of the time. >> most of the time. we like it when they are do come here. it's a good thing. we have patients from 135 countries. >> rose: you shouldn't do it because you want to treat kings you should do it because you want excellence as you say. but i'm just trying to put something on the sense of what's at risk unless we have a deeper appreciation of the challenge of medicine in the future. in te d[ of research, both interms od culture. >> i think excellence is at risk in science and in medicine in this country in we don't invest
in the innovations that you and i have talked about. it will be a race to the bottom and that's very much our message to government, it's our message to the private sector and we'll get this right. >> rose: we're not debating it in our political campaign. >> we're not but americans will demand, they deserve and i believe they will demand a sustainable high quality healthcare sits tell but they don't, nays right now charlie is they're going to be paying more out of pocket than the system we currently have and they're not going to be happy with that and they're going to say how do we get a better system and that's hit care reform 2.0. we haven't started that process yet. >> rose: when will we start. >> i'm not sure we'll start. there's a sense healthcare is done. >> rose: has affordable care dub better than what you / about what youexpected or not . >> the funds survey just came out and suggested for things that could be measured in the short term that is to say the
number of people who are uninsured who are now insured and whether or not folks are buying up better quality let's say medicare advantage plans, they get passing grades. in terms of what it will do to the total cost of healthcare the jury's still out on that. and again there's nothing in there, not very much in there yet about how do we modernize the system to sustain the excellence going forward. that's the next issue that needs to happen. >> rose: the partnership you have, what's that. >> so mayo clinic is focused like a laser on producing value. it's a term that people tonight really much like but better out comes at lower cost. the hard part of that, we can measure outcomes, say for care and more efficient care, longer live admissions and all that kind of thing. but the cost issue has been a problem. so years ago we paired up with the united health group and their component uptun and said
there's create an open innovation lab where you can pus data over 20 years. what people really spend in healthcare and we'll put our data of outcomes how things work and use big data tools to determine better outcomes, what's working in this open bell lab innovation we now have over 20 groups who joined us, other academic medical centers, big pharma, policy makers and so on putting their data in and then using big data tools to say well how did you get better outcome with parkinson's disease or breast cancer or heart surgery. and then what we'd like to do is create an open database where literally patients can look and say where is the best play to get this or that done. i want to get the diagnosis accurately. i want to have all the care i should be and no more than that. that will create a competitive open database marketplace.
>> rose: one of the interesting things about the internet in my experience, people who are affected by serious illness becomes addicts to the internet. they cannot get enough information for good reason for life and death. >> yes. of course it's trauma for patients to come and say i think i have this because here's my information. that's information it's not knowledge. it's a good thing and sometimes it's a bit of a nuisance when the patient comes and thinks they have things wrong with them. they're investing in their future and what's what our citizens need to do. >> rose: thank you for coming. >> pleasure. thank you for having me here. >> rose: thank you for joining us. see you next time. for more about this program and early episodes visit us on-line at cbs.org and charlierose.com. captioning sponsored by
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